Question

A child is admitted to the hospital with gastroenteri- tis. The physician orders D51/4 NS with 20 mEq KCL per 1000 ml to be administered at a rate of 50 ml per hour. The appropriate nursing action for this order would be to A. delay adding the KCL until the child has voided. B. ask why the physician didn’t include other elec- trolytes. C. question the physician why a hypertonic solution was ordered. D. monitor the child for fluid volume overload because of the fast rate. The answer is A. Potassium would not be added until the child has voided. Hyperkalemia would occur if kidney func- tion was impaired resulting in cardiac dysfunction. The other responses are incorrect. Fluid replacement is the main concern in gastroenteritis, the fluid is hypotonic and the rate is not excessive.

Short answer

The correct nursing action is A: delay adding KCL until the child has voided to prevent potential hyperkalemia due to impaired kidney function. The other options are based on incorrect assumptions regarding the treatment of gastroenteritis.

Step-by-step solution

Understanding the Order

Review and understand the physician's order: D51/4 NS with 20 mEq KCL per 1000 ml to be administered at 50 ml per hour. Recognize that the order is for a specific type and rate of IV fluid administration.

Reviewing Medical Knowledge

Recall that potassium (KCL) should not be added to the IV solution until it's confirmed that the child's kidneys are functioning properly. A child must void to demonstrate this, as an impaired kidney function can cause hyperkalemia and subsequent cardiac dysfunction.

Evaluating the Incorrect Responses

Understand that the other responses (B, C, D) are incorrect: B is invalid because the main concern is fluid replacement, not electrolyte composition. C is incorrect as the solution ordered is not hypertonic, and D is wrong because the administration rate of 50 ml per hour is not excessively high and unlikely to cause fluid volume overload.

Key concepts

Pediatric Nursing

In pediatric nursing, it's critical to tailor medical interventions to the unique physiological characteristics of children. Their bodies respond differently than adults to illnesses and treatments. For example, in the case of gastroenteritis in children, fluid loss through diarrhea and vomiting can lead to significant dehydration. The pediatric nurse must be adept at calculating accurate medication and fluid administration rates based on the child's weight and condition.

Furthermore, pediatric nurses are trained to observe for signs of improvement or deterioration. In the scenario given, a nurse would understand that administering potassium (KCL) without confirming kidney function could be dangerous, as children are particularly susceptible to the effects of electrolyte imbalances. The nurse's role in monitoring the child's voiding is essential before commencing with potassium-containing IV solutions.

IV Fluid Administration

Administering IV fluids is a common but critical component of patient care. In the context of gastroenteritis, where dehydration is a concern, prompt and accurate IV fluid replenishment is vital. The scenario described involves administering a solution of D51/4 NS with 20 mEq KCL per 1000 ml at a rate of 50 ml per hour, which is intended to replace both fluids and electrolytes.

The precise administration of IV fluids, especially in children, means being vigilant about the rate and composition of the fluids. A pediatric nurse must be skilled in using infusion pumps and calculating drip rates to ensure the child receives the correct volume of fluid as prescribed by the physician.

Potassium Chloride in IV Solutions

Potassium Chloride (KCL) is often included in IV solutions to replace potassium lost due to conditions like gastroenteritis. It's vital for maintaining heart and muscle function. However, the therapeutic window for potassium is narrow, and the body's balance of potassium must be carefully managed.

When preparing an IV solution that includes KCL for a pediatric patient, the healthcare provider must first ensure that the child's kidneys are functioning adequately, signified by voiding. An excess of potassium, or hyperkalemia, can have serious cardiac consequences, which is why the nurse in the exercise correctly delayed the addition of KCL until after the child voided.

Kidney Function Assessment

Kidney function assessment is essential before administering substances that are primarily excreted by the kidneys, such as potassium. The child's ability to void indicates that the kidneys are likely functioning and capable of excreting the additional potassium that would be administered through the IV.

In medical practice, there are various methods to assess kidney function, including laboratory tests and urine output monitoring. In children with gastroenteritis or similar conditions, particular care is needed because their fluid and electrolyte balance can be easily disturbed. Ensuring that they void before administering potassium-rich solutions is a key safety step to prevent hyperkalemia.